The management of Camp Alger and Camp Meade

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THE MANAGEMENT OF

CAMP ALGER AND

CAMP MEADE.

KEPKIHTBD FROM THB

Neto ITovfe ^elifcal 3Jout;nal
for September ^4, 1898.

V „ H')^'

1898. .

-iiifWASH

> Reprinted from the Ne^c York Medical Journal
S" for September 2J^, 1898.

ro

cD

THE MANAGEMENT OF CAMP ALGER
AND CAMP MEADE.

Headquarters Second Army Corps,
Camp Meade, Pennsylvania,
Chief Surgeon's Office, September 15, 1898.

To the Editor of the New York Medical Journal:

Sir : In reply to your letter of September 6tli request-
ing a statement of the facts relating to certain news-
paper reports with regard to the condition of Camp
Meade and to the health of the men in that camp, etc., I
have to thank you for the opportunity given me.

While this may not benefit me with the general pub-
lic, who are so ready to accept the attacks and criticisms
of newspapers and personal letters which might, and no
doubt were intended to, injure my professional and
official standing, yet I have the satisfaction of hoping
it will benefit the medical corps of the army in the esti-
mation of the medical profession, who alone are quali-
fied to judge.

I will preface my statement with a general history
of Camps Alger and Meade, of which I was and am
chief surgeon, and then take up under the several head-
ings the main points of interest to enable the profes-
sion to judge of the management of affairs by the medi-
cal department.

I was for the greater part of the time the only
regular surgeon in control of my department. One
other surgeon reported to me after some time, and
after doing duty in my office for a short time, I had to

2 CAMP ALGER AXD CAMP MEADE.

send him with two raw brigades to Cuba. Another
regular surgeon arrived about this time and assisted me
in my office, and when I learned of confusion in the
medical dapartment in Thoroughfare Gap, and of the
breaking out of typhoid fever at Manassas, I had to
send him there to bring order out of chaos; finally,
when the affairs of the large division hospital at Dunn
Loring had to be wound up after departure of most of
the troops from Camp Alger, he had to step into the
breach there.

The result was that I was practically the only sur-
geon with military training to look after the physical
welfare of thirty thousand men.

The division surgeons were volunteers with no
knowledge of army organization, and had to be taught
by me pari passu with their subordinates.

Any one who knows what it means to teach raw
troops how to procure food, water, fuel, clothing; to
carry out ordinary principles of hygiene; in addition
to this, to organize two large division hospitals, equip
the hospital department of several large commands for
active campaigns; to transfer, organize, clothe and
equip a hospital corps of about seven hundred men,
and to put them through some instruction — can guess,
not realize, the Herculean task I had to perform. Add
to this the introduction of a complete system of sani-
tation and medical organization embodied in circulars
and sanitary recoiiniiendations, and he will ask himself
if it is possible for one man to perform all this work.
If we consider in addition to all this the discomforts
of cam]) life, the heat of the southern summer, and the
great extent of the camp, covering as it does a surface of
a number of miles, it would be a matter of surprise to
any disinterested observer if no mistakes were com-
mitted; and still 1 believe I am able to prove by docu-
ments that everything that could be done by me to pre-
serve the healtli of the camp was recommended, and
in all cases ordered by the commaTiding general.

But issuing orders and iuiving them carried out are

CAMP ALGER AND CAMP MEADE. 3

two different things, and that" is where the cause of sick-
ness in Camp Alger lay. An aggregation of thirty thou-
sand men under the drawbacks of a camp, the fatigue of
the necessary military exercises and manual labor, the
men barely controlled by their officers (chums and towns-
men of the enlisted men), an absence of officers trained
in the knowledge of and recognizing the necessity for the
strictest sanitary measures, the men eating and drink-
ing inordinately, the food poorly cooked, no one to
teach the cooks or understanding the proper manage-
ment of the ration, so that the men were gorging for
seven days and starving for three — what else could be
expected but sickness ?

Since I have been the head of the sanitary depart-
ment, every possible accusation instigated by sensation-
alism, hostility to military rule, and self -laudation, has
been hurled against me.

Now what was the actual state of affairs under the
different heads of medical control?

1. Medical Supplies. — A howl about the scarcity
of medicines and equipments was raised soon after I
reached camp. I found about ten thousand men, with
a daily increase of several thousand. I knew that the
surgeon general had notified the governors of the sev-
eral States that it would be impossible to have adequate
medical equipment provided at such short notice, and
had requested them to supply their regiments with their
State outfit, and I had reason to expect that the ma-
jority would come so supplied. What was my dismay,
when I found an absolute insufficiency for more than a
week or two, with regiments streaming in calling for
ambulances to transport their sick, for medicines, for
shelter, and I had nothing to give them! I had re-
ceived my orders one day and was in camp the next,
finding the above state of affairs. I did the only thing
possible to lessen the probability of suffering by having
an order issued calling in all supplies and centralizing
the medical service, seizing upon the few regimental
hospitals to provide tentage and equipments for all, and

4 CAMP ALGER AND CAMP MEADE.

taking the few regimental ambulances, in order to be
able to convey the patients to the hospital and to isolate
measles and mumps.

No one suffered from this except those regimental
surgeons, who naturally disliked giving up what they
had provided for their special commands. It was the
counterpart of shipwreck or a North Pole expedition
demanding an equalization of rations.

The result was, however, disastrous to me, for with
newspaper reporters hungering for sensational accounts
and disappointed doctors and their satellites, I was held
up to the horror of mankind.

Medical supplies can not be bought like beef or oats,
and it took some time before rigid economy could be
relaxed, while complaints kept pouring into the papers
by surgeons whose expenditures I had to keep within
the lowest reasonable limits. The extravagance in the
use and waste of medicines was ahuost incredible. But
no one ever died and few suffered from lack of medical
supplies.

2. Water Supply. — The next thing which not only
perturbed the public mind, but even sanitarians, was the
water supply. " Tliis was a matter which should be
watched ! " It was ludicrous to imagine that a trained
sanitary officer needed advice on the subject.

My'first care tlie morning after I reached camp was
to get an engineer and tlie proprietor of the camping
grounds to locate tlie vaunt (h1 springs which^ had U'd
to acceptance of the site by the (juartennaster's depart-
ment, r found them to be surface drainage of insuffi-
cient (juantity, and at once had an order issued placing
them under guard and requiring all drinking water to
be boiled. The next stc]) was the development of a suffi-
cient and ])ure water supply, and to this end I accom-
panied the engineer officer in the selection of suitable
spols to drive wells. Their average de])th was a hun-
dred and twenty feet and they passed through thick
strata of rock.

Still, 1 took samples of tlie water and had them

CAMP ALGER AND CAMP MEADE. 5

analyzed in the laboratory of the surgeon general's office,
and wherever, as in a few instances, traces of organic
matter were discovered, the wells were condemned.

In order further to guard against possible contami-
nation I obtained three hundred sets of Maignen and
Berkefelt filters, and had minute orders given as to
their use.

On my arrival at Camp Meade I accompanied the
commanding general in an inspection of the proposed
camp sites, had all so-called springs, which were only
the result of subsoil drainage, at once condemned, the
other sources of water supply — namely, wells driven over
two hundred feet and a limestone spring and water sup-
ply of Middletown, Pennsylvania — analyzed, and found
them pure.

It would tire my readers to learn about the many
reports I made concerning the disregard of sanitary
recommendations, but I believe that I have established
the fact that while Camp Alger had an insufficient sup-
ply of water, every care was taken by me to do my share
toward amplifying it.

3. Sanitaky Police. — The sanitary policing of the
camps was well regulated by orders issued on my recom-
mendation, but these orders were persistently disobeyed.
The privies as a rule were filthy. Sanitary inspections
by regimental medical officers were either neglected, or
their recommendations were disregarded by the colonels.
I never learned of this disregard, as no reports were
made to me by regimental, brigade, or division sur-
geons, in spite of daily injunctions thereon. Every one
seemed satisfied with the heauty of his camp, but ap-
parently no one ever looked after the dejecta. When I
made personal and special inspections, matters were
remedied for a day or two, and they then relapsed into
the old filth. I had not the time to institute disciplinary
measures.

On June 3d I had advised individual covering of
faecal matter, principally for the purpose of prevent-
ing infection by flies, and an order to that effect was

6 CAMP ALGER AND CAMP MEADE.

issued by the commanding general, but in the undis-
ciplined condition of the troops this order could not be
rigidl}^ enforced until the commencement of August.
Since this time a sentry was placed at each privy to see
that the order was complied with, and even with this
precaution instances were observed where the order wa^
evaded. The neighboring woods and cornfields were
used in preference by the men, with the natural result
that most of the surface water became infected. Sen-
tries posted to prevent the defiling of woods and corn-
fields would not report their comrades, and it was
consequently absolutely impossible to control the situ-
ation.

4. Food. — As to the food, I recommended as early
as June 3d regulations regarding it. They were speed-
ily ignored and, as a rule, ignorance of the order was
pleaded to me as excuse.

About the same time I recommended prohibition of
the sale in camp of various articles of food which in
my opinion were deleterious to the health of the troops.
An order tliereon was issued by the general, but could
not be enforced, owing to limitation of his authority
to within the confines of the camp.

5. Typhoid Fever. — As to the origin of typhoid
fever, there wore a number of foci of infection, some of
which could be reached, some could not. A few ex-
amples will demonstrate this.

Soon after tlie occupation of the camp, cases of
typhoid fever occurred, coming from a nuiuber of regi-
uKMits, and the patients were removed to tlic general
hospital at Fort Myer. They were sporadic, one or two
to a thousand men, and evidently imported, because
the camp had not been in existence long enough to allow
the necessary time for incubation. The cases became
more frequent, although the water supply, officially ap-
proved and provided, remained pure; but numbers of
surface s})rings were all around the camps (they were
more convenient than the pumps), and the men did
not have to wait there for tlieir turn, so, in spite of
prohibition, this use of surface water was general.

CAMP ALGER AND CAMP MEADE. ^

A constant anxious search was made by me for pre-
ventable infection.

Thus it was found that a number of men of the
Sixth Massachusetts Volunteer Infantry, who had been
on provost duty at East Falls Church and had used
the water there, were taken with typhoid.

The water supply of the provost guard could not be
controlled.

The First New York Cavalry, who in their camp
used either boiled, Hygeia, or Apollinaris water exclu-
sively, had a number of cases. The only explanation
which could be found was that these men were con-
stantly on patrol duty and found the cool wells in
neighboring farmhouses more acceptable than the warm
H^ygeia water in their canteens. It is a well-known fact
that many people in Washington, who spend the sum-
mer on these farms, return with typhoid.

Another source was found in a surface well driven
by men of a Pennsylvania regiment in one company,
which had a great many cases of typhoid, while the
adjoining companies were free. Fortunately for these,
the well owners guarded their well jealously. The regi-
. mental surgeons knew of it, but it apparently did not
^ctrike them as unsanitary. A company in another regi-
ment was severely affected, while the adjoining ones
were free. In that case the milk was suspected, but
nothing was proved.

The fact is that if the men had confined themselves
to the water provided and to the food issued, if they
had practised ordinary care, and if their officers had
compelled them to submit to sanitary regulations, there
would have been no typhoid fever.

6. Sanitary Eecommendations. — No one man in
my position could overcome the indifference to sanita-
tion. A list of the sanitai:y recommendations made
will show to what extent my care, for the health of, the
troops was carried :

1. Water-supply development.

2. The location of wells according to need.

8 CAMP ALGER AND CAMP MEADE.

3. Eegiilations about drinking water and the care of
its supply.

4. The cooking of food.

5. The care of privies.

6. The disposal of refuse.

7. The chemical examination of water.

8. The prohibition of the sale of pies, ice cream,
sandwiches, etc.

9. Eecommendations for contracts with laundries,
etc.

10. The employment of contract surgeons.

11. The flooring of tents.

12. The overcrowding of tents and their close prox-
imity.

13. The establishment of urinals.

14. The purification of drinking water.

15. The removing of regiments from unhealthy loca-
tions.

16. The utilization of condemned tents for cover-
ing privies.

17. The replacing privy pits with earth closets, if
the camp is to be continued.

18. The employment of cooking instructors.

19. Application for an analyst.

20. Milk inspection.

21. Detail of sanitary inspector.

22. The use of filters.

23. The change of camj)s.

24. The individual covering of fjrcal matter.

25. Detailed instructions for the use of filters.

26. Analysis of water sup])ly.

27. The policing of groumls around hydrants.

28. Directions concerning disinfection.

29. l\('i»oii Ml)out carelessness in the shi])ment of
bread.

;'.(). lirconunendation for military excursions.

31. The sterilization of the men's blankets.

32. Reports on water supply.

33. Inspection of cleanliness of the men.

34. liaising the tent floors.

CAMP ALGER AND CAMP MEADE. 9

7. Selection of Camps. — Finally, as to the selec-
tion of Camp Alger as a camping ground, it must be
remembered that the location was selected by the war
department, and that neither myself nor the medical
department in Washington was consulted. The only
fault I could find was the lack of space and the scarcity
of water. Both were corrected as rapidly as possible,
and as soon as typhoid fever appeared other camp sites
were examined, but found objectionable. Finally, it was
decided to move the command to Thoroughfare Gap,
and the Second Division went there; then the war de-
partment decided to move the whole command to Camp
Meade.

An army corps is not like a regimental camp, and
sites where all the desirable features can be found are
scarce. Before Camp Meade was decided upon a large
number of places were visited by officers from the war
department, among whom was one of the most distin-
guished hygienists of the medical corps. Colonel Smart.

This paper — I should rather call it a sketch — has
been written under numberless interruptions, which are
inevitable in the sanitary and medical administration
of thirty thousand men, and hence omissions and im-
perfections may reasonably be pardoned.

A. C. GiRARD,

Lieutenant Colonel and Chief Surgeon, Second Army
Corps.

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